FUD Team of experts! Sorry I haven’t been around much lately, my business has absolutely exploded. I now need some help.
My youngest son has broke his collarbone into three segments and is going to have surgery tomorrow to plate and screw it. He has not had anesthesia before and I want to give him the most information possible.
Our current plan - no meals after 8:00 am, surgery is last one in the afternoon/early evening.
Target a Blood Sugar that won’t alarm Anesthesia - so 120-150.
Is this the right target range?
Have low snacks ready for recovery.
Any instructions you would provide to the Anesthesia person?
I just had a colonoscopy – probably a much quicker procedure and not full general anesthesia, but a couple of thoughts:
120-150 seems reasonable to not freak out anesthesiologist
did you talk w endo about dropping basal after meals end? My recommendation (I am MDI) was to use only 80%, which I did for my am shot, but I went to 60% for my pm shot; mostly b/c I had played 2 hrs of tennis in the late morning while not eating anything all day
if you can, give anesthesiologist a way to watch blood sugar during surgery. I wear an Apple Watch so they could always look at mine. Make sure they have an IV fluid bag containing dextrose available if necessary (I don’t think any of this is common at a GI center, so they had to locate a dextrose bag for me!)
UGH to your son’s shoulder situation – I am so sorry. Keep us posted and I’ll keep him in my thoughts. Hoping your business has exploded in a great way. Good luck tmrw!
Not speaking for your son, but only for myself, I would target a bit higher and reduce my basals.
While I am awake/aware, I would say those numbers would be fine, but under anethesia, I would rather go higher, especially knowing that you can always give insulin later, but you cannot give carbs during.
Also note sure what the anesthesiologist thinks is normal, especially for a younger person.
I broke my collarbone last year and had surgery almost exactly 12 months ago. It went really well and I hope your sons does as well.
120-150 is fine. They’ll be happy if its higher, but not lower. Bring apple juice, etc, in case they go low without lunch.
Bring a CGM receiver. 13 years ago my anesthesiologist wouldn’t even look at my pump and CGM, this time he was not only aware of it, he asked to watch the numbers during the procedure. YMMV.
Depending on how they treat after surgery expect changes in insulin needs. I think I got a steroid dose or something before I woke up and my insulin needs were 300% for a few days after the procedure
@Chris Sorry for the troubles…and sorry if this is too late for consideration. The numbers you state sound about right. My Endo routinely recommends about 80% of normal basal rate (using an Omnipod Dash) to allow increased BG to the area you mention. I wouldn’t push the snacks after surgery unless you son is alert and wants something, I’d recommend juice of some variety or glucose tabs as less impacting on the digestive system.
It depends on the anesthetist and his/her knowledge of T1s, insulin, and what your son uses for administration. I recommend trying to discuss as soon as possible. Also depends on the length of the surgery, sounds like it might be extensive. Would he be comfortable using his CGM? His phone app? His pump? His pump app?
Also, warn anesthetist/doc about use of steroids or be aware of the potential impact of them on BG, can cause significant rise. Lastly, warn/be aware of use dextrose/similar IV drips during and post surgery. Docs use “standard” post surgical orders with many stipulating dextrose drips because some patients don’t eat for hours after, these can drive BG’s sky high; better to work with doc to use saline drips and use other fluids/solid foods as feasible.
Hi @Chris
Sorry, I am probably too late if the surgery is today.
First of all, welcome back! Good to see you. We’ve missed you.
Second, not sure if you were going to do this, you did not mention it. But if he is allowed to have his phone with him you can monitor his BG while he is in there too. And really the only thing that matters is if it drops. 150 is no big deal for a while.
How long is the surgery?
Also, others have mentioned this too, but you did not say if you were doing it - cutting basal would be super helpful!
So my son is out of surgery and in recovery. Your help was much appreciated. He went in with a reduced basal and a flat line 200 and the surgery went well. Hopefully the pain is manageable.
Thank you! I have heard that the pain is bad, but they did have to dig one of his bones parts out of his chest muscle. So hopefully the pain meds work their wonders.
My doctor friend says the xray looks great, and his blood sugar has been stable. So there is that.
I’m glad to hear he is doing okay! What a nice stable line!!!
Just a note, besides the reduction in basal and aiming for a higher number. Sometimes they give dextrose in a drip, so it’s good to remind them not too. Plus they like to give some cortisone during some surgeries to cut inflammation without telling you they are going too.
I had a recent surgical procedure. Someone came in the room as I was being prepped with an IV bag.
Me: “What’s in that bag?”
Him: “Lactacted ringer.”
Me: “Not for me, saline.”
Him: " It’s not dextrose!"
Me: “Lactose is sugar.”
Him: "I’ll check with the anesthesiologist.
I got saline.
Edit on 11/10/2023
I am going to correct myself as to lactated ringers and blood glucose. I had a minor surgery to instal a mediport today. I didn’t notice that the drip was LR. Not only did my BG not rise during the long wait, they were fitting me in, but just before being taken into the OR I suspended insulin and removed my pump because even at basal reduced to about 30% normal, BG was dropping. So the LR did not cause BG to rise. At least anecdotally I stand corrected.
Hope his recovery is ok! I have had to take oral steroids a few times over the past few years after surgeries/procedures and it makes my blood sugars just completely out of control, like my insulin is water. Hopefully he is not experiencing that!
I got curious about this so I did a quick lit search. I can’t find any studies that show Ringer’s lactate as being problematic for diabetics. One review looked directly at BG management with Ringer’s vs. normal saline and found no difference:
This was a retrospective review, so it’s got the usual caveats. I’d be glad to know if others have better information.
Lactated Ringer’s solution was prepared, in which concentration of potassium was either 10 or 20 mEq.l-1, and that of glucose was 1.4%. Each preparation was infused into 10 patients who underwent surgical operations under general anesthesia. Effects of this fluid therapy on changes in serum potassium and blood sugar were studied comparing with infusion of lactated Ringer’s solution in which concentration of potassium was 10 mEq.l-1, and glucose was 0.7%. Both serum potassium and blood sugar levels were maintained within normal ranges with the lactated Ringer’s solution containing 20 mEq.l-1 of potassium and 1.4% of glucose. On the other hand, the former tended to decrease and the latter tended to increase with the lactated Ringer’s solution containing potassium 10 mEq.l-1 and glucose 1.4%. We consider that the homeostatic effect with the lactated Ringer’s solution containing 20 mEq.l-1 of potassium and 1.4% of glucose would be to lower blood glucose level by concomitant intracellular influx of potassium and glucose. Therefore these high potassium lactated Ringer’s solutions balanced adequately with glucose are useful for fluid therapy during surgical procedure under general anesthesia. [Changes in blood sugar levels following infusion of lactated Ringer's solution with various concentrations of potassium and glucose] - PubMed
This medicine (lactated ringers) may affect your blood sugar levels. Check with your doctor right away if you have increased thirst or increased urination. If you notice a change in the results of your urine or blood sugar tests, or if you have any questions, talk with your doctor. Lactated Ringer'S (Intravenous Route) Side Effects - Mayo Clinic
This study showed that there was a significant increase in blood sugar levels intra-operatively when RL was used with as well as without supplemental dextrose. Addition of dextrose increased the incidence of intraoperative hyperglycemia to 50% as compared to only 12% when RL alone was used. Effect of Using Ringer's Lactate, with and without Addition... : Anesthesia Essays and Researches
